Predictors of linkage to care for a nontargeted emergency department hepatitis C screening program
Predictors of linkage to care for a nontargeted emergency department hepatitis C screening program
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DOI：
10.1016/j.ajem.2019.11.034
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发表时间：
2020-07-01
影响因子：
3.6
通讯作者：
Hess, Erik P.
中科院分区：
文献类型：
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作者：
Blackwell, Joshua A.;Rodgers, Joel B.;Hess, Erik P.
目的：我们在一家学术三级急诊科（ED）实施了一项非靶向、选择性退出的丙型肝炎病毒检测和联系治疗（LTC）项目。尽管研究显示基于ED的HCV检测项目的关键作用，但对于通过非靶向ED检测策略确定的患者，LTC的预测因素尚未明确。为了优化HCV患者的健康结果，我们试图确定LTC失败的预测因素。方法：这是一项回顾性队列研究，研究对象是2015年8月至2018年9月期间在急诊科接受HCV检测并通过RNA检测确认为慢性HCV感染的成年患者。我们使用逻辑回归来评估候选预测因子与主要结局（LTC失败）之间的关系，LTC失败被定义为患者从edd出院后未被HCV治疗提供者看到。结果：在53,297名患者中，1,674名（3.1%）患者在确认性检测中有HCV， 355名（21%）患者与护理相关。LTC失败的预测因素包括年龄较小（OR 0.96, 95% CI 0.95-0.97）、白人（OR 1.65, 95% CI 1.23-2.22）、无家可归（OR 1.91, 95% CI 1.19-3.08）、药物使用（OR 1.77, 95% CI 1.34-2.34）和精神疾病共病（OR 2.16, 95% CI 1.59-2.94）。有显著医学合并症（OR 0.57, 95% CI 0.41-0.78）或HIV合并感染（OR 0.11, 95% CI 0.03-0.46）的患者发生LTC失败的可能性较小。结论：五分之一的HCV感染患者通过基于ed的非靶向检测成功联系到HCV治疗提供者。LTC失败的预测因素可以指导有针对性的干预措施的发展，以提高LTC的成功。(C) 2019 Elsevier Inc.版权所有。
Objective: We implemented a nontargeted, opt-out HCV testing and linkage to care (LTC) program in an academic tertiary care emergency department (ED). Despite research showing the critical role of ED-based HCV testing programs, predictors of LTC have not been defined for patients identified through the nontargeted ED testing strategy. In order to optimize health outcomes for patients with HCV, we sought to identify predictors of LTC failure.Methods: This was a retrospective cohort study of adult patients who were tested for HCV in the ED between August 2015 and September 2018 and were confirmed to have chronic HCV infection through RNA testing. We used logistic regression to assess the relationship between candidate predictors and the primary outcome, LTC failure, which was defined as a patient not being seen by an HCV treating provider after discharge from the ED.Results: Of 53,297 patients tested, 1,674 (3.1%) had HCV on confirmatory testing, and 355 (21%) linked to care. Predictors of LTC failure included younger age (OR 0.96, 95% CI 0.95-0.97), white race (OR 1.65, 95% CI 1.23-2.22), homelessness (OR 1.91, 95% CI 1.19-3.08), substance use (OR 1.77, 95% CI 1.34-2.34), and comorbid psychiatric illness (OR 2.16, 95% CI 1.59-2.94). Patients with significant medical comorbidities (OR 0.57, 95% CI 0.41-0.78) or HIV co-infection (OR 0.11, 95% CI 0.03-0.46) were less likely to experience LTC failure.Conclusions: One in five HCV-infected patients identified by ED-based nontargeted testing successfully linked to an HCV treating provider. Predictors of LTC failure may guide the development of targeted interventions to improve LTC success. (C) 2019 Elsevier Inc. All rights reserved.